Tuesday, July 15, 2014

An expected deluge of data and information about patients,
providers, outcomes, and needed efficiencies is pushing the healthcare industry
to rapid change. But more than dealing with just the volume of data is required. Interoperability, security and the ability to adapt rapidly to the lessons in the data are all essential.

In preparation for the conference, BriefingsDirect had the opportunity to interview Jason Lee, the new Healthcare and Security Forums Director at The Open Group. The discussion is moderated by me, Dana Gardner, Principal Analyst at Interarbor Solutions.

Here are some excerpts:

Gardner: I'm looking forward to the Boston conference next week and
want to remind our listeners and readers that it's not too late to sign
up to attend. You can learn more at www.opengroup.org.

Let’s start by talking about the relationship between Boundaryless
Information Flow, which is a major theme of the conference, and
healthcare. Healthcare perhaps is the killer application for
Boundaryless Information Flow.

Lee:
Interesting, I haven’t heard it referred to that way, but healthcare is
17 percent of the US economy. It's upwards of $3 trillion. The costs of
healthcare are a problem, not just in the United States, but all over
the world, and there are a great number of inefficiencies in the way we
practice healthcare.

We don’t necessarily intend to be inefficient, but
there are so many places and people involved in healthcare, it's very
difficult to get them to speak the same language. It's almost as if
you're in a large house with lots of different rooms, and every room
you walk into they speak a different language. To get information to
flow from one room to the other requires some active efforts, and that’s
what we're undertaking here at The Open Group.

Gardner:
What is it about the current collaboration approaches that don’t work?
Obviously, healthcare has been around for a long time and there have
been different players involved. What are the hurdles? What prevents a
nice, seamless, easy flow and collaboration in information that creates
better outcomes? What’s the holdup?

Many barriers

Lee:
There are many ways to answer that question, because there are many
barriers. Perhaps the simplest is the transformation of healthcare from a
paper-based industry to a digital industry. Everyone has walked into a medical
office, looked behind the people at the front desk, and seen file upon
file and row upon row of folders, information that’s kept in a written
format.

When
there's been movement toward digitizing that information, not everyone
has used the same system. It's almost like trains running on different
gauge track. Obviously if the track going east to west is a different
gauge than going north to south, then trains aren’t going to be able to
travel on those same tracks. In the same way, healthcare information
does not flow easily from one office to another or from one provider to
another.

Gardner: So not only do we have
disparate strategies for collecting and communicating health data, but
we're also seeing much larger amounts of data coming from a variety of
new and different places. Some of them now even involve sensors inside
of patients themselves or devices that people will wear. So is the data
deluge, the volume, also an issue here?

Lee:
Certainly. I heard recently that an integrated health plan, which has
multiple hospitals involved, contains more elements of data than the Library of Congress.
As information is collected at multiple points in time, over a
relatively short period of time, you really do have a data deluge.
Figuring out how to find your way through all the data and look at the
most relevant [information] for the patient is a great challenge.

Gardner:
I suppose the bad news is that there is this deluge of data, but it’s
also good news, because more data means more opportunity for analysis, a
better ability to predict and determine best practices, and also
provide overall lower costs with better patient care.

We, like others, put a great deal of effort into describing the
problems, but figuring out how to bring IT technologies to bear on
business problems.

So it seems like the stakes
are rather high here to get this right, to not just crumble under a
volume or an avalanche of data, but to master it, because it's perhaps
the future. The solution is somewhere in there, too.

Lee:
No question about it. At The Open Group, our focus is on solutions. We,
like others, put a great deal of effort into describing the problems,
but figuring out how to bring IT technologies to bear on business
problems, how to encourage different parts of organizations to speak to
one another and across organizations to speak the same language, and to
operate using common standards and language. That’s really what we're
all about.

And it is, in a large sense, part of the
process of helping to bring healthcare into the 21st Century. A number
of industries are a couple of decades ahead of healthcare in the way
they use large datasets -- big data,
some people refer to it as. I'm talking about companies like big
department stores and large online retailers. They really have stepped
up to the plate and are using that deluge of data in ways that are very
beneficial to them -- and healthcare can do the same. We're just not quite
at the same level of evolution.

Gardner: And to
your point, the stakes are so much higher. Retail is, of course, a big
deal in the economy, but as you pointed out, healthcare is such a much
larger segment. So just making modest improvements in
communication, collaboration, or data analysis can reap huge rewards.

Quality side

Lee:
Absolutely true. There is the cost side of things, but there is also
the quality side. So there are many ways in which healthcare can improve
through standardization and coordinated development, using modern
technology that cannot just reduce cost, but improve quality at the same
time.

Gardner: I'd like to get into a few of
the hotter trends. But before we do, it seems that The Open Group has
recognized the importance here by devoting the entire second day of
their conference in Boston, that will be on July 22, to healthcare.

Maybe
you could provide us a brief overview of what participants, and even those
who come in online and view recorded sessions of the conference at http://new.livestream.com/opengroup should expect? What’s going to go on
July 22?

Lee: We have a packed day. We're very excited to have Dr. Joe Kvedar, a physician at Partners HealthCare and Founding Director of the Center for Connected Health, as our first plenary speaker. The title of his presentation is “Making Health Additive.”

It will become an area where standards development and The Open Group can be very helpful.

Dr.
Kvedar is a widely respected expert on mobile health, which is
currently the Healthcare Forum’s top work priority. As mobile medical
devices become ever more available and diversified, they will enable
consumers to know more about their own health and wellness.

A
great deal of data of potentially useful health data will be
generated. How this information can be used -- not just by consumers but
also by the healthcare establishment that takes care of them as
patients -- will become a question of increasing importance. It will
become an area where standards development and The Open Group can be
very helpful.

He
is going to talk about how enterprise architecture -- which is really
about getting to solutions by helping the IT folks talk to the business
folks and vice versa -- has helped the State of Colorado develop their health insurance exchange.

After the plenaries, we
will break up into three tracks, one of which is healthcare-focused. In
this track there will be three presentations, all of which discuss how
enterprise architecture and the approach to Boundaryless Information
Flow can help healthcare and healthcare decision-makers become more
effective and efficient.

Care delivery

One presentation will focus on the transformation of care delivery at the Visiting Nurse Service
of New York. Another will address stewarding healthcare transformation
using enterprise architecture, focusing on one of our platinum members, Oracle, and a company called Intelligent Medical Objects, and how they're working together in a productive way, bringing IT and healthcare decision-making together.

Then,
the final presentation in this track will focus on the development of
an enterprise architecture-based solution at an insurance company. The
payers, or the insurers -- the big companies that are responsible for
paying bills and collecting premiums -- have a very important role in
the healthcare system that extends beyond administration of benefits.
Yet, payers are not always recognized for their key responsibilities
and capabilities in the area of clinical improvements and cost
improvements.

With the increase in payer data brought on in large part by the adoption of a new coding system -- the ICD-10
-- which will come online this year, there will be a huge amount of
additional data, including clinical data, that become available. At The
Open Group, we consider payers -- health insurance companies (some of
which are integrated with providers) -- as very important stakeholders
in the big picture.

In the afternoon, we're going to
switch gears a bit and have a speaker talk about the challenges, the
barriers, the “pain points” in introducing new technology into the
healthcare systems. The focus will return to remote or mobile medical
devices and the predictable but challenging barriers to getting newly
generated health information to flow to doctors’ offices and into
patients records, electronic health records, and hospitals' data-keeping and data-sharing systems.

Payers are not always recognized for their key responsibilities and
capabilities in the area of clinical improvements and cost improvements.

We'll have a panel of experts that responds to
these pain points, these challenges, and then we'll draw heavily from
the audience, who we believe will be very, very helpful, because they
bring a great deal of expertise in guiding us in our work. So we're very
much looking forward to the afternoon as well.

Gardner:
I'd also like to remind our readers and listeners that they can take
part in this by attending the conference, and there is information about
that at the opengroup.org website.

It's
really interesting. A couple of these different plenaries and
discussions in the afternoon come back to this user-generated data.
Jason, we really seem to be on the cusp of a whole new level of
information that people will be able to develop from themselves through
their lifestyle, new devices that are connected.

We hear from folks like Apple, Samsung, Google, and Microsoft.
They're all pulling together information and making it easier for
people to not only monitor their exercise, but their diet, and maybe
even start to use sensors to keep track of blood sugar levels, for
example.

In fact, a new Flurry Analytics survey showed 62 percent increase
in the use of health and fitness application over the last six months
on the popular mobile devices. This compares to a 33 percent increase in
other applications in general. So there's an 87 percent faster uptick
in the use of health and fitness applications.

Tell me
a little bit how you see this factoring in. Is this a mixed blessing?
Will so much data generated from people in addition to the electronic
medical records, for example, be a bad thing? Is this going to be a garbage in, garbage out,
or is this something that could potentially be a game changer in terms
of how people react to their own data -- and then bring more data into the
interactions they have with healthcare providers?

Challenge to predict

Lee:
It's always a challenge to predict what the market is going to do, but I
think that’s a remarkable statistic that you cited. My prediction is
that the increased volume of person-generated data from mobile health
devices is going to be a game changer. This view also reflects how the
Healthcare Forum members (which includes members from Capgemini, Philips, IBM, Oracle and HP) view the future.

The
commercial demand for mobile medical devices, things that can be worn,
embedded, or swallowed, as in pills, as you mentioned, is growing ever
more. The software and the applications that will be developed to be
used with the devices is going to grow by leaps and bounds.

As
you say, there are big players getting involved. Already some of the
pedometer-type devices that measure the number of steps taken in a day
have captured the interest of many, many people. Even David Sedaris,
serious guy that he is, was writing about it recently in The New Yorker.

What
we will find is that many of the health indicators that we used to have
to go to the doctor or nurse or lab to get information on will become
available to us through these remote devices.

There are already problems around interoperability and connectivity of information in the healthcare establishment as it is now.

There
will be a question of course as to reliability and validity of the
information, to your point about garbage in, garbage out, but I think
standards development will help here This, again, is where The Open
Group comes in. We might also see the FDA exercising its role in ensuring safety here, as well as other organizations, in determining which devices are reliable.

The
Open Group is working in the area of mobile data and information
systems that are developed around them, and their ability to (a) talk to
one another, and (b) talk to the data devices/infrastructure used in
doctors’ offices and in hospitals. This is called interoperability and
it's certainly lacking in the country.

There are
already problems around interoperability and connectivity of information
in the healthcare establishment as it is now. When patients and
consumers start collecting their own data, and the patient is put at the
center of the nexus of healthcare, then the question becomes how does
that information that patients collect get back to the doctor/clinician
in ways in which the data can be trusted and where the data are helpful?

After all, if a patient is wearing a medical device,
there is the opportunity to collect data, about blood-sugar level let's
say, throughout the day. And this is really taking healthcare outside of
the four walls of the clinic and bringing information to bear that can
be very, very useful to clinicians and beneficial to patients.

In
short, the rapid market dynamic in mobile medical devices and in the
software and hardware that facilitates interoperability begs for
standards-based solutions that reduce costs and improve quality, and all
of which puts the patient at the center. This is The Open Group’s
Healthcare Forum’s sweet spot.

Game changer

Gardner:
It seems to me a real potential game changer as well, and that
something like Boundaryless Information Flow and standards will play an
essential role in. Because one of the big question marks with many of the
ailments in a modern society has to do with lifestyle and behavior.

So
often, the providers of the care only really have the patient’s
responses to questions, but imagine having a trove of data at their
disposal, a 360-degree view of the patient to then further the cause of
understanding what's really going on, on a day-to-day basis.

But
then, it's also having a two-way street, being able to deliver perhaps
in an automated fashion reinforcements and incentives, information back
to the patient in real-time about behavior and lifestyles. So it strikes
me as something quite promising, and I look forward to hearing more
about it at the Boston conference.

Any other thoughts
on this issue about patient flow of data, not just among and between
providers and payers, for example, or providers in an ecosystem of care,
but with the patient as the center of it all, as you said?

Lee:
As more mobile medical devices come to the market, we'll find that
consumers own multiple types of devices at least some of which collect
multiple types of data. So even for the patient, being at the center of
their own healthcare information collection, there can be barriers to
having one device talk to the other. If a patient wants to keep their
own personal health record, there may be difficulties in bringing all
that information into one place.

There are issues, around security in particular, where healthcare will be at the leading edge.

So
the interoperability issue, the need for standards, guidelines, and
voluntary consensus among stakeholders about how information is
represented becomes an issue, not just between patients and their
providers, but for individual consumers as well.

Gardner: And also the cloud
providers. There will be a variety of large organizations with
cloud-modeled services, and they are going to need to be, in some
fashion, brought together, so that a complete 360-degree view of the
patient is available when needed. It's going to be an interesting time.

Of
course, we've also looked at many other industries and tried to have a
cloud synergy, a cloud-of-clouds approach to data and also the
transaction. So it’s interesting how what's going on in multiple
industries is common, but it strikes me that, again, the scale and the
impact of the healthcare industry makes it a leader now, and perhaps a
driver for some of these long overdue structured and standardized
activities.

Lee: It could become a leader. There
is no question about it. Moreover, there is a lot healthcare can learn
from other companies, from mistakes that other companies have made, from
lessons they have learned, from best practices they have developed
(both on the content and process side). And there are issues, around
security in particular, where healthcare will be at the leading edge in
trying to figure out how much is enough, how much is too much, and what
kinds of solutions work.

There's a great future ahead
here. It's not going to be without bumps in the road, but organizations
like The Open Group are designed and experienced to help multiple
stakeholders come together and have the conversations that they need to
have in order to push forward and solve some of these problems.